Basic Information
| Provider Information | |||||||||
| NPI: | 1821357666 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | MONACO AND EVANS DENTAL, P.C. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | KIDS CHOICE DENTAL, VISION, BRACES | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2250 S MONACO PKWY | ||||||||
| Address2: | |||||||||
| City: | DENVER | ||||||||
| State: | CO | ||||||||
| PostalCode: | 802225814 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204704291 | ||||||||
| FaxNumber: | 3037665599 | ||||||||
| Practice Location | |||||||||
| Address1: | 19266 E FAIR DR | ||||||||
| Address2: | |||||||||
| City: | AURORA | ||||||||
| State: | CO | ||||||||
| PostalCode: | 800163851 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7204704291 | ||||||||
| FaxNumber: | 3037665599 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/14/2012 | ||||||||
| LastUpdateDate: | 05/14/2012 | ||||||||
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| AuthorizedOfficialLastName: | MANSHADI | ||||||||
| AuthorizedOfficialFirstName: | DAVOOD | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7204704291 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DDS | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1223G0001X | Y | 193400000X SINGLE SPECIALTY GROUP | Dental Providers | Dentist | General Practice |
No ID Information.